| How I treat cobalamin (vitamin B12) deficiency. | |
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MedLine Citation:
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PMID: 18606874 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The challenges in medical management of cobalamin deficiency lie in attention to the unique pathophysiology that underlies cobalamin deficiency, more than in the mechanics of therapy. The central physiologic principles are that clinically important deficiency is more likely to occur (and progress) when intrinsic factor-driven absorption fails than when diet is poor and that most causes take years to produce clinically obvious deficiency. Transient defects have little clinical impact. The key management principle is the importance of follow-up, which also requires knowing how the deficiency arose. The virtues of these principles are not always fully appreciated. Recent developments have made diagnosis and management more difficult by diminishing the ability to determine cobalamin absorption status. Clinicians must also grapple with premature medicalization of isolated, mild biochemical changes that added many asymptomatic cases of still undetermined medical relevance to their caseload, often expanded by inflated cobalamin level criteria. The potential for misattribution of cobalamin-unrelated presentations to nongermane cobalamin and metabolite abnormalities has grown. Pathophysiologically based management requires systematic attention to each of its individual components: correctly diagnosing cobalamin deficiency, reversing it, defining its underlying cause, preventing relapse, managing the underlying disorder and its complications, and educating the patient. |
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Authors:
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Ralph Carmel |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2008-07-07 |
Journal Detail:
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Title: Blood Volume: 112 ISSN: 1528-0020 ISO Abbreviation: Blood Publication Date: 2008 Sep |
Date Detail:
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Created Date: 2008-09-09 Completed Date: 2008-10-30 Revised Date: 2013-06-05 |
Medline Journal Info:
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Nlm Unique ID: 7603509 Medline TA: Blood Country: United States |
Other Details:
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Languages: eng Pagination: 2214-21 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, New York Methodist Hospital, Brooklyn, and Weill Medical College, Cornell University, New York, NY 11215, USA. rac9001@nyp.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Disease Management Humans Malabsorption Syndromes Practice Guidelines as Topic* Treatment Outcome Vitamin B 12 / metabolism, therapeutic use Vitamin B 12 Deficiency / diagnosis, physiopathology, therapy* |
| Grant Support | |
ID/Acronym/Agency:
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DK32640/DK/NIDDK NIH HHS |
| Chemical | |
Reg. No./Substance:
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68-19-9/Vitamin B 12 |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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